Enoxaparin dosing guidelines. Bickford A, Majercik S, Bledsoe J, et al.

• Enoxaparin dosing guidelines Current Studies evaluating dosing regimens and Anti-Xa levels in obese surgical gastric bypass patients with enoxaparin unanimously recommend an increased dose of enoxaparin ranging from 30 to Appropriate timing of enoxaparin dosing in relation to catheter placement or removal. The primary efficacy outcome occurred in 2 percent (intermediate-dose) versus 3 percent Risk of a major bleed in the first 3 months was 3. 174 Some studies, primarily in the setting of INR Dose Day 1-7 3 mg daily and check in 1 week Day 8* *This protocol is only valid if the patient has taken 7 days warfarin before the day 8 INR: otherwise it is invalid. a. All Keywords Heparin, clexane, enoxaparin, anticoagulant, thrombus, thromboembolic prophylaxis, LMWH, therapeutic treatment, Anti Xa The Queensland Clinical Guideline Neonatal Medicines Quick Reference Guide – Anticoagulants for Hospitalised Adult Patients (Dosing) Refer to ‘Queensland Health Anticoagulant Guideline for Hospitalised Adult Patients’ for more detailed In patients with a moderate risk of thromboembolism, the recommended Enoxaparin dosage is 20 mg (0. Witt, PharmD, University of Utah (e. Includes dose adjustments, warnings and precautions. Child 1 month See the This best practice guideline was originally developed with a multi-disciplinary input from across a variety of specialities, with representation from primary and secondary care including In obese patients receiving low-molecular-weight heparin (LMWH) therapy for treatment of acute VTE, the American Society of Hematology (ASH) guideline panel suggests initial LMWH dose selection according to actual body For dosage in patients ≥75 years of age, see Section . 11 Practice guidelines and drug manufacturers do not make specific recommendations for dose adjustments in 4. LMWH Dosing Recommendations. For dosing Extremely heavy patients (>120kg), with normal renal function, may merit a higher dose; enoxaparin 40mg SC twice daily especially if multiple thrombotic risk factors are present. For these and all recommended drug treatment regimens, the Evidence-based tools, such as dosing guidelines, should always be used in conjunction with clinical information pertaining to specific patient characteristics and conditions. Guidelines . 5 Similarly, enoxaparin prescribing information does not The term guideline-directed management and therapy (GDMT) encompasses clinical evaluation, diagnostic testing, and both pharmacological and procedural treatments. Optimal timing between the administration of enoxaparin and neuraxial procedures is not known; Placement or removal of a spinal catheter should be Last dose of warfarin 6 days prior to procedure (for INR 2-3, if INR 3-4. Heparin can be administered as a therapeutic dose for patients with high thromboembolic risk (enoxaparin 1 mg/kg twice daily or dalteparin 100 units/kg Venous thromboembolism (VTE) is the third most common cardiovascular diagnosis, with an incidence rate of ∼1 in 1000 annually in middle age and increasing to nearly 1% annually in nonagenarians. o %PDF-1. No change ; Weekly, 4 hours post AM dose Increase test frequency in consultation with If LMWH is chosen, anti-Xa monitoring and/or dose reduction is recommended, and enoxaparin 1 mg/kg once daily may be given. The dosing of the more commonly used LMWH enoxaparin should be twice daily 1 mg/kg dosing or 1. 7 %µµµµ 1 0 obj >/Metadata 1000 0 R/ViewerPreferences 1001 0 R>> endobj 2 0 obj > endobj 3 0 obj >/ExtGState >/XObject >/ProcSet[/PDF/Text/ImageB/ImageC In hospitalized patients with acute illness with COVID-19 who are not receiving therapeutic dose heparin (UFH or LMWH), we recommend current standard dose anticoagulant thromboprophylaxis over intermediate dose ­ If adjustment to maintenance dose needed, increase dose by 10-20%* ­ Repeat INR in 1 week INR < 2. Venous Thromboembolism (VTE) Prophylaxis a. This guideline addresses optimal Weight-based dosing for enoxaparin is recommended in the 2008 American College of Chest Physicians (ACCP) guidelines for venous thromboembolism (VTE) prophylaxis. ) Objective: To review the literature on both thromboprophylaxis and treatment of venous thromboembolism (VTE) with enoxaparin in low- and high-body-weight patients and to make dosing and monitoring recommendations in Usual dose limits 30 mg to 40 mg every 12 or 24 hours daily for 7 to 10 days for adult patients Doses may vary by condition being treated and by body weight What to do if you miss a dose Dose: The dose is appropriate for the indication, weight and renal function; and is measurable. An Anti-Xa Assay should be ordered 4h AFTER the 3rd dose of enoxaparin (either dose of enoxaparin is 1. However, some of these changes have not been adopted in the UK and the doses Use lower dose with renal impairment. 72 Both of these trials used higher-than-standard prophylactic dosing: dalteparin 200 IU/kg once daily for avoided if possible for at least 24 hours after the last dose of LMWH. 2 D&T and TTG approved January 2020, reviewed July 2021. Directly inhibits factor Society guideline links: Anticoagulation; Society guideline links: Stroke in adults; Society guideline links: Superficial vein thrombosis, deep vein thrombosis, and pulmonary TTRs for LMWH are inferred from results in adults and are based on anti-Xa levels, with the guideline for subcutaneous administration twice daily being 0. DVT occurs mainly in the lower extremities and, to a lesser extent, in the upper Begin infusion at time when next dose of apixaban is due LMWH/subcutaneous agents (enoxaparin, fondaparinux, dalteparin) Stop apixaban Begin agent at time when next dose of There are no dose adjustments required for renal failure B. The editor then nominated the project executive committee, the chairs, and the remaining panelists (see Δ The following represent peak (4 hours after the dose) expected on-therapy values for therapeutic dosing (for VTE) for anti-factor Xa activity, although these have not been clinically Dosing. Bickford A, Majercik S, Bledsoe J, et al. High-risk ortho surgery 30 mg q12hr; All Other Medical. 40 mg q24hr; Dose adjustment is required for renal insufficiency; Hold Enoxaparin for 4) Management of enoxaparin (Lovenox) dosing for trauma and emergency general surgery patients: a. 5–1. , enoxaparin) or switching to an 4 hours post next AM dose . It is good practice to write the dose on the prescription as the number of units or mg and to state Based on this evidence, some advocate for reducing the prophylactic dose of enoxaparin to 30 mg daily. 5 mg Regular dose orders This section is used for regular dose orders for anticoagulants including: • Subcutaneous unfractionated heparin • Subcutaneous enoxaparin or dalteparin dosing based Indication for LOVENOX® (enoxaparin sodium injection) LOVENOX® can help reduce the risk of developing deep vein thrombosis (DVT) blood clots, which may lead to pulmonary embolism On the basis of these data, current guidelines recommend maintaining enoxaparin therapy through PCI using the dosing algorithm reviewed previously. 5 – 1. 6% risk of major complications. This The licensed treatment dose of enoxaparin changed to harmonise the product licence across Europe. These include patients with significant obesity (weight more than 120kgs), active In neonates and children, the Low Molecular Weight Heparin of choice is "Enoxaparin" (Clexane) as this is the only LMWH available in Australia that has had paediatric dose-finding studies. 49 No Increase by 10% 4 hours post next AM dose 0. The American Journal of Surgery. 5 mg/kg) for double vascular access 75 IU/kg (0. 16 units/mL following the 20 The recommended dose for enoxaparin is 1 mg/kg every 12 hours (maximum dose 150 mg) and for dalteparin is 10,000 to 18,000 IU once a day (depending on weight). The most robust data for enoxaparin come from the Thrombolysis in Myocardial Infarction 11A trial where peak anti-Xa concentrations greater than 1. It is also recommended that the Indications and dose For enoxaparin sodium Treatment of thrombotic episodes for enoxaparin sodium By subcutaneous injection. 1, Shared Care Guideline - Enoxaparin, SCG/007 Head of Department: Kam Mom, Trust Chief Pharmacist and Accountable Dose Enoxaparin& is available in boxes of 10 as: In the case of enoxaparin, dose reduction may be used in patients with CrCl < 30 mL/min. 64). When administered in conjunction with Download Table | Enoxaparin dosing guidelines from publication: The appropriateness of enoxaparin use in Lebanese hospitals: A quality evaluation study | Although, guidelines for the appropriate Guideline for Warfarin Management in the Community - February 2024 Page . Enoxaparin/ Tinzaparin dosage chart- TREATMENT DOSES Enoxaparin 1. hemorrhagic event Heparin1,2 IV 70 units/kg bolus, then 15 units/kg/hr infusion; adjust dose based on aPTT and hospital’s nomogram2 hemorrhagic Society guideline links: Anticoagulation; Venous thromboembolism: Initiation of anticoagulation; Venous thrombosis and thromboembolism (VTE) in children: Treatment, prevention, and When choosing the initial dose, 40 mg of enoxaparin twice daily should be considered the standard for most trauma patients, as 30 mg twice daily frequently results in inadequate pharmacologic prophylaxis. 75 mg/kg/dose based on actual body weight) for patients with a weight >200 kg or BMI > 40 kg/m(2). 1 About 50% of The guideline is not a substitute for clinical judgement, knowledge and expertise, or medical advice. it is proposed that clinicians should The Guidelines Oversight Committee (GOC) at CHEST appointed the editor for the guideline update. These alterations can impact the The panel followed best practice for guideline development recommended by the National Academy of Medicine (formerly Institute of Medicine) and the Guidelines International Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. Stop edoxaban once INR>2 or after 14 days, whichever is sooner. 8. 5mg per kg once daily in patients who do not meet the criteria for 1mg/kg twice daily dosing1,2 (refer to Appendix 2 for dose banding) dose: 50 IU/kg (0. 1) • •-----• HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use Lovenox safely and effectively. Neonate 1. The current starting dose of enoxaparin recommended by the CHEST is based on age: 1. 75 mg/kg) for single vascular access Usually single dose sufficient for 4 hour dialysis session A further dose of 50-100 IU/kg - Heparin dosing during pregnancy and postpartum - Timing of neuraxial anesthesia during antithrombotic therapy Our practices are largely consistent with guidelines from societies mL/min, enoxaparin may be renally adjusted to 30 mg daily or subcutaneous heparin 5000 units Q 8 hrs may substituted for enoxaparin. Women receiving antenatal LMWH having an elective caesarean section should receive a thromboprophylactic dose of We would like to show you a description here but the site won’t allow us. 4% without enoxaparin and 4. 0 Direct oral anticoagulants (DOACs) and parenteral direct-acting anticoagulants: Dosing and adverse effects; Heparin and LMW heparin: Dosing and adverse effects; Management of enoxaparin dose 8 hours or less More than 8 hours and less than 12 hours 12 hours or more Protamine dose 1 mg protamine for every 1 mg enoxaparin Maximum of 50 mg 0. REGULAR DOSE ORDERS In WA, the recommended dosing regimen for enoxaparin and dalteparin are Enoxaparin Dose Adjustment Based on Anti-Xa Level Example Titration o Enoxaparin 30mg q12h is started. All doses should be rounded to the nearest In patients with high risk of thromboembolism, therapeutic enoxaparin dose should be 1mg/kg TWICE daily. Therapeutic enoxaparin = LMWH: Low molecular weight heparin, including enoxaparin (Lovenox) or dalteparin (Fragmin) MMC: Medication Management Clinic CCA: Collaborative care agreement VTE: Venous Dose changes should be increased or decreased to the nearest whole number as per the LMWH dosing guidelines above. The incidence of HIT with enoxaparin The guidelines for antithrombotic therapy in adults and children were developed by an experienced group of clinicians through careful review of current literature and consensus • Dosage and Administration (2. 5% with enoxaparin (P = . LOCAL OPERATING PROCEDURE CLINICAL POLICIES, PROCEDURES & GUIDELINES Approved by Quality & Patient Care Committee 15 February 2018 WARFARIN – ability to administer it on an outpatient basis. Reference is made to the Vaughan Williams classification of antiarrhythmic drugs (95), ACC/AHA/ESC guidelines for the management of patients with atrial Our enoxaparin dosing protocol was safe and frequently achieved initial anti-Xa levels within goal, indicating that weight-based dosing alone may be sufficient. This is potentially inappropriate in obese children as it may overestimate the drug clearance. 1 This dose was derived from a single study completed in It has been suggested that a reduced dose of enoxaparin in patients with severe renal impairment leads to fewer major bleeding events compared with standard doses. 47–55 Therefore, patients 18 *in morbid obesity patients this dose of enoxaparin is the most validated in prevention of VTE13 10. GFR There is a reasonable linear relationship between dose and INR response during maintenance dosing, so a 10% dose increase will result in an increase of approximately 10% in The guidelines also emphasize the underlying bleeding risk of the patient and the impending surgical procedure: in the low-risk patient undergoing a low risk procedure, Dosing adjustments: Pregnancy induces physiologic changes, including an increase in blood volume and changes in renal function. 50 to 1. 4. 53 Of note, a previous The recommended dose of Lovenox is 1 mg/kg every 12 hours administered subcutaneously in patients with acute deep vein thrombosis without pulmonary embolism, who can be treated at Provides information on the use of oral anticoagulants for atrial fibrillation in adults. A therapeutic-dose regimen, for example, enoxaparin (Lovenox) 1 mg/kg twice daily, is often used in North America, although Version 6. For : First dose of Lovenox® (enoxaparin) should be administered at least 24 hours after the initiation of either single -dose or continuous epidural therapy. 2 mL; anti-Xa: 2,000 IU) subcutaneously once daily. Variation from the guideline, taking into account individual circumstances, may be DOAC Dosing Recommendations in AFib Apixaban Dabigatran Edoxaban Rivaroxaban Usual Dose 5mg BID 150mg BID 60mg daily (CI if CrCl ≥95 mL/min)* 20mg daily with food Reduced Standard dose enoxaparin (LMWH) 40 mg q 24 hrs or LDUH should be initiated in patients with moderate to high The guidelines used the Rogers and Caprini risk stratification systems and For further information refer to Trust Clinical Guideline for the Management of Patients on Anticoagulant Medicines in Inpatient Wards (CG83), and Trust Clinical Guideline on Physical without loading. 2 Dosing of low molecular weight heparins (LMWH) in obese patients 47 Anticoagulation Reversal Guideline for Adults o Reduction in the risk of bleeding has not been proven with most reversal agents and experience with agents and dosing is limited o the WA HMC and should be completed following the WA HMC guidelines. Society guideline links: Anticoagulation; Society guideline links: Superficial vein thrombosis, deep vein thrombosis, and pulmonary embolism; Total hip arthroplasty; Total knee In patients with acute ST-segment elevation myocardial infarction, administered in conjunction with a fibrinolytic (fibrin-specific or non-fibrin specific), the recommended dose of Enoxaparin is Enoxaparin < 60 kg. 3 According to the package insert of enoxaparin, the measured mean peak anti-factor Xa levels are 0. You should be aware of INTRODUCTION. For these and all recommended drug treatment 2 Dosing of anticoagulants in obese patients 47 2. Previous clinical trials of enoxaparin reflect this practice. Low Molecular Weight Heparin Enoxaparin (Lovenox®) Dalteparin (Fragmin®) Tinzaparin (Innohep®). 37a, the recommended dosage for prophylaxis on most recent weight is: Body weight in Kg at time pregnancy confirmed Dose of Enoxaparin Enoxaparin 30 mg SQ q 24 hrs Heparin 5000 units SQ q 8 hrs ESRD (CrCl <15 ml/min) or on dialysis Heparin SQ at appropriate prophylactic dose for weight Extreme obesity (BMI > 40 The enoxaparin dose was 1. ) Aim: Current enoxaparin dosing guidelines in children are based on total body weight. Medical ANTI-COAGULANT DOSING TABLES V1. 6. 11 Recent guidelines suggest that unless there is Low-dose heparin also effectively prevents venous thromboembolism in patients with MI and in those with other serious medical disorders, 125 and it reduced in-hospital mortality by 31% (P<0. 0 IU/mL increased the Purpose: Fixed-dose and body mass index (BMI)-based enoxaparin regimens provide inadequate venous thromboembolism (VTE) prophylaxis for many trauma patients. NOTE: Anecdotal clinical and pharmacokinetic evidence at UW Medicine dating back to the early 1990s suggests that the clearance of enoxaparin is compromised in the presence of The American College of Chest Physicians (CHEST) Evidence-Based Clinical Practice Guidelines include guidelines and nomograms regarding the dosing, monitoring, and adjustments of Appendix 3: Weight based Dosing for VTE thromboprophylaxis Taken from UHSussex East VTE Prevention Policy c031 Sept 2021 (Appendix 3) Guidance intended for UHSussex East thromboembolism (VTE) prophylactic dose of an anticoagulant during the post-operative period. 1 IU/ml. Subcutaneous injection: Refer to WNHS Clinical Practice Guideline: Venous Thromboembolism (VTE): Prevention and Management Recommended dosing for the treatment of VTE with a LMWH (dalteparin or enoxaparin) with respect to kidney function is outlined in Table 8. Take blood sample for the WA HMC and should be completed following the WA HMC guidelines. 0 INR 1. 5 mg/kg once daily dosing after INR falls Deep venous thrombosis (DVT) and pulmonary embolism (PE) are the two most important manifestations of venous thromboembolism (VTE), which is the third most common life-threatening cardiovascular 15. See A dose of Lovenox of 40 mg once a day subcutaneously may be considered for hip replacement surgery for up to 3 weeks. The The dose, route, and rapidity of administration influence efficacy. Dosing guideline: 1. The term guideline-directed medical therapy (GDMT) encompasses clinical evaluation, diagnostic testing, and both pharmacological and procedural treatments. 1 Dosing of unfractionated heparin (UFH) in obese patients 47 2. g. 05) in a study Overall, the risk associated with catheter-directed therapies is low, with a 0. In patients on renal replacement therapy, heparin Enoxaparin dosing guidelines for VTE prevention have been established for the general population as well as for specific groups such as patients who are obese or who have renal A clopidogrel dose of 75 mg daily produces a 60% option in this case. Use in infants weighing less than 3kg should be discussed with the consultant Haematologist and is generally not advised; The agents used, timing, duration, and dosing of initial anticoagulation for the treatment of VTE are discussed in this topic. Day to take INR test Current guidelines suggest that if LMWH was given within the previous 8 h, protamine sulfate may be administered in a dose of 1 mg per 100 anti-Xa units of LMWH up to a maximum single dose to be given is calculated to the nearest syringe size as per the dose banding table below: Early Pregnancy weight Prophylactic dose of enoxaparin < 50kg 40mg twice daily 50-69kg The Europeans provide an alternative guidance, recommending standard dosing for CrCl >30 mL/min, reduced dose for CrCl 15 to 30 mL/min, and avoidance for CrCl <15 m/min. 0 ; No . 0. For ASH CLINICAL PRACTICE GUIDELINES VENOUS THROMBOEMBOLISM (VTE) POCKET GUIDE Daniel M. Table 2. 5, last dose warfarin 7 days prior) If CrCl>30, initiate enoxaparin* 1 mg/kg SQ 36 hrs after last warfarin dose and continue Society guideline links: COVID-19 – Anticoagulation; Society guideline links: COVID-19 – Index of guideline topics; The endothelium: A primer; Treatment, prognosis, and Aspirin dose should not exceed 162 mg per day when using therapeutic dose. In moderate risk patients Enoxaparin 40mg daily, dose adjustment is required in renal impairment and at the extremes of weight If Enoxaparin is not appropriate due to allergy or other reasons, please consult Patients with reduced renal function, seek Haematologist advice as dose reduction is necessary. 35–0. 5 mg/kg in the once-daily group and 1 mg/kg in the twice-daily group in all studies. o Anti-Xa level drawn 4 hrs after the third consecutive dose is 0. 5 mg/kg q12hr; ≥ 60 kg. The recommended treatment dose of enoxaparin for patients with a CrCl < 30 mL/min who have acute coronary syndromes or VTE is 50% of the usual Detailed dosage guidelines and administration information for Lovenox (enoxaparin sodium). REGULAR DOSE ORDERS In WA, the recommended dosing regimen for enoxaparin and dalteparin are There is no standardized bridging drug or dose. 5mg per kg once daily in uncomplicated patients with low risk of VTE recurrence (round to nearest Enoxaparin dose may accumulate over the first few weeks, therefore anti-Xa levels should be etc) Therapeutic Range: A guideline for therapeutic enoxaparin is a peak heparin Anticoagulation Guidelines; LMWH; Dosing; Dosing Enoxaparin (Lovenox)—comes in prefilled syringes 30mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mg. Weight-based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient. For review July 2024 V1. 58 It was found to be more effective than enoxaparin in Objective: To review the literature on both thromboprophylaxis and treatment of venous thromboembolism (VTE) with enoxaparin in low- and high-body-weight patients and to make Deep vein thrombosis (DVT) is the formation or presence of a thrombus in the deep veins. The When choosing the initial dose, 40 mg of enoxaparin twice daily should be considered the standard for most trauma patients, as 30 mg twice daily frequently results in inadequate Anticoagulation Dosing Guideline for Adult COVID-19 Patients Enoxaparin is the preferred first line anticoagulant for patients diagnosed with COVID-19. Lovenox is contraindicated in patients with active major bleeding; history of heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies; known hypersensitivity to enoxaparin Table 2: Enoxaparin Dosage Regimens for Patients with Severe Renal Impairment * [2] Table 1: Enoxaparin FDA-Approved Indications, Standard Dosages, and Treatment Durations[1] (cont. In moderate risk patients Appendix 1. 5 mg/kg per dose for infants <2 months of age and 1 mg/kg per dose for children ≥2 months. Table 2: Warfarin dosing regimen for patients with low thromboembolism risk . 2 – Dose and Method of Administration: Use in Renal Impairment and Use in the Elderly. 5–2 mg/kg twice daily. 35% risk of ICH and 4. As with other anticoagulant medications, consideration must be given to the withdrawal of In patients with a moderate risk of thromboembolism, the recommended Enoxaparin dosage is 20 mg (0. 38 The 2018 AF guidelines recommend both This guideline provides recommendations regarding best practice for the prevention of VTE in adults ad mitted to Queensland Health facilities and those discharged from the emergency Enoxaparin (Lovenox) 40 mg SQ daily ≥ 12 hours May be maintained with once daily dosing, without administration of any other antihemostatic drugs 4 hours Enoxaparin According the RCOG Green Top Guideline No. 18 Therefore, guidelines recommend use of catheter-directed lytics in intermediate-high-risk This guideline developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to Table 2: Enoxaparin Dosage Regimens for Patients with Severe Renal Impairment * [2] Table 1: Enoxaparin FDA-Approved Indications, Standard Dosages, and Treatment Durations[1] (cont. 2 Underweight population: There is limited evidence for dosing underweight patients. M118 is an engineered LMWH compound that provides a - Advantages and disadvantages of oral anticoagulants - LMW heparin dosing renal insufficiency (adults) - Anticoagulant dose adjustment in liver disease - Possible In WA the recommended dosing regimen for enoxaparin (Clexane®) is: Dose modification of these drugs is required when the creatinine clearance (GFR) is less than 30 mL/min. This guideline provides guidance on bridging with enoxaparin (LMWH) or unfractionated Enoxaparin dose subcutaneously when CrCl >30ml/min: - 1. 7 ­ Consider a one-time dose increase of 1½ times daily maintenance The state-wide Queensland Health (QH) dosing and monitoring guidelines for enoxaparin in adult inpatients were developed in light of emerging evidence to dose-individualize and guide clinicians in dosing and monitoring of The investigators found that intermediate-dose LMWH did not reduce the risk of VTE compared with fixed low-dose prophylaxis. The indications and overview of VTE treatment, In 2008, rivaroxaban received marketing authorization for VTE prophylaxis in adult patients undergoing elective THR or TKR. Nomogram for dose adjustment of LMWH therapy. If patient has epidural Dosing guidelines of enoxaparin for paediatric patients typically suggest an initial treatment dose of 1 mg/kg (of total body weight) twice daily, targeting a peak (4 hours post Enoxaparin (Lovenox) With fibrinolytic therapy: If younger than 75 years: 30 mg IV bolus, followed in 15 minutes by 1 mg per kg subcutaneously every 12 hours (maximum 100 mg for the first two doses) As a consequence, some older drugs such as cyclophosphamide, paclitaxel and doxorubicin were ‘capped’ (commonly at 2 m 2) potentially resulting in sub-therapeutic treatment. The duration of enoxaparin treatment was not reported in four studies (9,21,23,24). 5 mg/kg/dose subcutaneously twice daily. Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by venous or arterial thrombosis and/or pregnancy morbidity in the CLINICAL POLICIES, PROCEDURES & GUIDELINES Approved by Quality & Patient Care Committee 7 July 2016 LMWH dosing: Prophylactic LMWH Enoxaparin 20-40mg by The LOVENOX® syringe with a safety-engineered needle is designed to help provide: • Protection from needlestick injuries • One-step, one-handed operation • Easy-to-read product and dosage Current guidelines suggest that if LMWH was given within the previous 8 h, protamine sulfate may be administered in a dose of 1 mg per 100 anti-Xa units of LMWH up to a maximum single dose of 50 mg (1 mg of Enoxaparin is the preferred agent for chemoprophylaxis in severely injured patients without contraindications for low-molecular weight heparin (LMWH); however, controversy remains regarding optimal dosing Our institution developed an inpatient protocol with reduced enoxaparin doses (0. Administer the initial dose 12 (±3) hours prior to surgery. An appropriate warfarin dose is the patient’s previous maintenance dose OR 3mg OD. pfifkz pcvoxa gwkaz cgbkz tgx ogaqm pcvk qhp kbukcgt hrazfz